Dizziness myths

If you are experiencing dizziness, you will find that many people will be happy to share their stories and give advice.  It is natural to seek advice about a problem from family and friends.  Often it is helpful.  Sometimes it is not.

Some stories that we hear from our patients week in and week out reflect common misconceptions, either about a particular disease, or how to treat that disease.  We review here some of the most frequently encountered misconceptions.

Myth #1: “They said I have vertigo.”

This is not exactly a myth, but it is misleading.  “Vertigo” is not a disease or diagnosis; rather, it is a symptom that can be caused by many different diseases.

 We will illustrate this with an analogy by taking the example of “tummy ache,” because most people have had a tummy ache and can relate to this.  “Tummy ache” is not a disease.  It is a symptom that can be caused by a huge range of diseases, ranging from gas, to appendicitis, to a bowel obstruction, to diverticulitis, to gallstones, to pancreatic cancer.  While each of these disorders can present with a “tummy ache,” they are very different diseases, with different ways of being tested and treated, and with very different prognoses.

 “Vertigo,” unfortunately, is similar in that there is an enormous range of diseases that can cause this symptom.  So when a person reports, “They said I had vertigo,” that does not go very far in clarifying the underlying cause, nor does it lead you to a specific treatment path likely to be of any help.

Myth #2: “They said I have VOR.”

This is not exactly a myth, but it is misleading.  The abbreviation “VOR” stands for “vestibulo-ocular reflex,” a normal reflex that moves the eyes in response to head movements so that the eyes can “stay on target.”  Telling a patient that “You have VOR” is simply saying that they have a normal eye movement reflex.

 Perhaps the health care providers who tell patients that they “have VOR” mean that “there is an abnormality with your vestibulo-ocular reflex.”  This is more correct insofar as it acknowledges a problem with the VOR, but it is nearly useless because it does not clarify what that problem is.

Myth #3: “You can use the Epley maneuver on both sides.”

The Epley maneuver is a specific physical therapy maneuver that is used to treat benign paroxysmal positional vertigo (the most common cause of dizziness) involving a part of the inner ear called the posterior canal (the most commonly affected part).  The tricky thing about this is that when a person is diagnosed with benign paroxysmal positional vertigo (BPPV), it may not always be clear which ear and which canal is involved.  Patients seeking quick relief from their dizziness, and well-intentioned health care providers trying to help them, may attempt doing “the Epley maneuver on both sides” to “cover all the bases.”

 Usually this will not work.  The reason is that because the geometry of one inner ear is the “mirror image” of the opposite ear, performing the Epley maneuver on one side will “undo” whatever benefit might have been obtained when it was performed on the other side.  Therefore, performing the Epley maneuver on both sides will just be like treading water, and will not usually achieve symptom relief.

Myth #4: “Steroids treat vestibular neuritis.”

Vestibular neuritis is a common cause of dizziness, and is believed to result from inflammation of the balance-related nerve between the ear and the brain.  Because “inflammation” appears to be involved, some of the early research about treatments attempted using various steroids.  Many subsequent studies have shown that steroids appear to be no better than placebo (a “sugar pill”) in the treatment of vestibular neuritis.

Myth #5: “Migraines have to include headache.”

Migraine is a common problem, and has been studied extensively, yet remains somewhat poorly understood.  Migraine can cause “non-pain” symptoms, such as dizziness (sometimes called “vestibular migraine”), nausea, vomiting, visual distortions and many others.  In some patients, their “migraine” may cause those “non-pain” symptoms even when no headache is present.  In other words, actual head pain need not be present when a person is experiencing the non-pain parts of migraine.

Myth #6: “There is no test for Ménière’s disease.”

Ménière’s disease is a progressive degenerative inner ear disorder that causes episodes of vertigo (usually lasting hours) accompanied by one-sided ear symptoms such as fullness, hearing loss and tinnitus (extra sounds that should not be there).  Many patients are given the impression that there is “no test” for Ménière’s disease, but this is incorrect.

 While Ménière’s disease is not always easy to diagnose, there are some tests that support the diagnosis, starting with a simple hearing test.  Several other tests (usually only available in specialized centers) can also help confirm the diagnosis.

Dispel myths about dizziness and get on the path to correct diagnosis and appropriate treatment!